Provider Demographics
NPI:1881718955
Name:MILLER, SUSAN LYNN WILSON (LPC LMFT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LYNN WILSON
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 RIVER RUN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4861
Mailing Address - Country:US
Mailing Address - Phone:770-992-8611
Mailing Address - Fax:
Practice Address - Street 1:6667 VERNON WOODS DR NE STE B27
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3216
Practice Address - Country:US
Practice Address - Phone:404-429-3732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2008-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004839101YP2500X
TX19484101YP2500X
TN000038101YP2500X
TN000184106H00000X
TX005061106H00000X
GA001055106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist